form 6 incorrect

7/22/2019 Form 6 Incorrect

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Form 6

http://forums.studentdoctor.net/showthread.php?p=12639410

http://www.usmle.net/step-1/messages2006a/201142.html

2. 46 year old woman with a chronic illness and a picture of a gigantic heart. What disorder did she have?

alcoholic cardiomyopathy, ASD, mitral stenosis, primary pulmonary HTN, systemic HTN (systemic HTN?)

Alcoholics -> wet beri beri -> dilated cardiomyopathy (systemic HTN causes concentric

hypertrophy which doesn't increase the size of the heart... just decreases ventricular volume)

So the answer is

1. Compared w/ freshly secreted bile, the proportion of what is decreased in bile stored in the

gallbladder?

Bilirubin, Ca, cholesterol, potassium, water (ans: water)

A 43yr old female with slow relaxation of stretch reflexes and hoarse voice. Plasma TSH level is low that

increases in concentration after she is given TRH. The cause of hypothyroidism in what?

I thought it is Hypothalamus (tertiary hypothyroidism), but the correct answer is Pituitary gland

2. benzene causes

3. Norepinephrine solution bathing cardiac myocytes. An increase in what leads to an increased work by

the muscle?

overlap of thin and thick filaments, sarcoplasmic Ca concentration, sarcoplasmic phosphocreatine,

stiffness of the series elastic elements

NE -> b1 receptor -> inc c AMP -> inc Ca2+ -> cont raction (answer is s arcoplasm ic Ca conc )

4. 17 year old girl with episodes of visual loss. There's a picture of her optic disc. What is the problem?

optic atrophy, optic neuritis, papilledema, retinal infarction, retrobulbar infarction

Headaches + visu al loss = I thou ght i t was p api l ledema from th e pic

22yo marathon women with stress fracture and decreased bone density. Is it due to estrogen def? If yes,

then why is it deficient in 22 yo girl?

I t has som eth ing to do w i th GnRH dysfunct ion w i th extreme exerc ise. So loss of norm al GnRH

excretion ult im ately leads to lack of estrogen.

married 78 yo man who took 10 temazepam pills. Which one is the most important in assessing his risk

for suicide?

-early morn awakening with decr.appetite

-family history of suicides

-male gender

-marital status
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-his belief that temazepam would kill him.

The last one?

Yeah, i t 's the last one. If he just too k a bunc h of tem azepam bec ause he was stressed o ut, rather

than try ing to ki l l h imsel f , that wou ld def in i tely make you th ink he 's not p lanning on comm it t ing

suicid e, at least not intentio nal ly

I guess I'm overthinking with this one:

49 yo woman hasn't slept 2 wks, denies previous history of sleep difficulty, drunk 1 bottle of wine for the

past week, but hasn't drunk in the past. Demands to be seen by the head of the department. Speech is

rapid, pressured, she is irritable. She got major depressive disorder 6 years ago. What's her Dx now?

-alcohol withdrawal

-alcohol halucinosis

-alcoholism

-bipolar disorder (ans)

-cyclothymic disorder: milder form of bipolar disorder

For cyclothymia they 100% have to tell you she's been having minor mania and depression bouts for at

least 2 years. Same thing with dysthymia (minor depression for 2 years).

Bipo lar disord er - pressured sp eech, irr i tabi l i ty, lack o f sleep, etc. (DIG FAST)

Fish oil/olive oil in preventing of renal disease in patients with IgA nephropathy. Over the next 5 years:

incidence of end-stage renal disease significantly lower in group that took fish oil. What is the design

study? Cohort is not answer, controlled trial is answer

The key is that the researchers made the patients take either fish oi l or ol ive oi l . So it 's a

randomized tr ial or whatever the choice said . Things l ike cohort stud ies and c ase-contro l d on ' t

invo lve any m anipu lat ion by the exper imenters. The people being stud ied do whatever they w ant

and the researchers just ob serve and record what happens.

Another biostat:

4 columns with UTI in children, what is the median number?

median value there were 4 bars for 0-3, the 0 and 3 bars were similar in size, so median value was the

larger bar (either 1 or 2).

Pretty sure it w as 1. Don't h ave the exact question , but w asn' t i t 100 people total , 30 withou t a UTI

and 25 with 1 UTI. So the m edian value wou ld be the 50th value. Since values 31-55 (when placed

in sequ ential order) are al l 1 UTI, the answ er is 1.

Question about mannitol: so will it cause only decrease of water reabsorption? Na will be reabsorbed in

kidneys and this is why osmolarity goes up, right? As for the mannitol Q, mannitol is an osmotic diuretic

(so volume goes down and sodium concentration up)


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Mannitol caus es loss of free water. So think abo ut there being essential ly no chang e in any

electro ly tes. If you just lose w ater , then your serum osmo la li ty wi l l increase

2) 6 y/o girl with dark urine and periorbital edema, noted in the morning after waking, for the past 3 days.

Physical exam shows mild HTN and ankle swelling. Urinalysis shows the prsence of RBCs, red blood cell

tubular casts, and increased protein concentration. Over the next few days, urine output is diminished

despite adequate fluid intake. Which of the following is the most likely location of the dz process?A) Glomerular

B) Interstitial

C) Postrenal

D) Prerenal

E) Tubular

42) A 31 y/o woman has had several episodes of retrosternal chest pain while at rest during the past 6

months. The most recent episode occurred while she was asleep and produced several minutes of ST

segment elevation on a home cardiac monitor. She has no known cardiac risk factors. Which of hte

following events in a large eicardial artery is most likely responsible for the chest pain?

A) Endothelial cell dysfunction

B) Formation of a thin fibrous-capped plaque

C) Neutrophilic infiltration within the intima

D) Plaque rupture and coronary embolization

E) Plaque rupture and mural hemorrhage

A - prinzmetals angina. complete occlusio n of the artery can prod uce ST elevation. Plus youn g

patient (31 yo) with no cardiac risk facto rs (only thin g to real ly consid er @ this age is

hyp ercholesterolem ia w/ early MI, but the question s tem says no card iac risk factors)

1) Four days after admission to the hospital with multiple fractures sustained in a motor vehicle

collision, a 27 year old man has the sudden onset of shortness of breath. His respirations are30/min. Doppler ultrasonography of the lower extremities shows a DVT, and a spiral CT scan of

the chest shows evidence of multiple subsegmental pulmonary emboli. Anticoagulant therapy is

begun. One week later, a follow up CT scan of the chest is done to evaluate atypical chest pain.

Results show no abnormalities, and the pain was considered to be MSK. Collateral circulation

from which of the following best explains the lack of identifiable pulmonary parenchymal infarcts

in this patient?

A) Bronchial arteries

B) Bronchial veins

C) Pulmonary arteries

D) Pulmonary veins

E) SVC

It's bronchial arteries, isn't it? Because it's about parenchymal infarcts.

yes

48) Certain chromosomal abnormalities can result in rudimentary development of the cerebral

hemispheres. Which of the following labeled structures in the xsection of a nl brain stem is expected to be

most underdeveloped as a result of such an anomaly?


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(Pic attached)

I get that it's Pateau's syndrome... Could it be E for the CST?

1. 51-year-old woman has 9 lb weight loss over past 6 mo. Smoked 2 packs cigarrettes per day for 20 yrs.

No meds, normal vitals. Labs:

Hemoglobin - 17

Hematocrit - 52%

Leukocytes - 5100

urea - 17

creatinine - 1

RBC/hpf in urine - 14

What's her problem?

endometrial carcinoma

polycythemia vera

renal carcinoma

renal vein thrombosis

2. You inject 2L isotonic saline. How much ends up extracellular?

I thought the answer would be 0.6L as usually fluid volume is 2/3 intracellular and 1/3 extracellular, but

that was not even an answer choice...

I put 1.6

Social phobia: really afraid to give presentations. excessive fear of embarrassment in a social situation

(public speaking, using public restroom)

5.Hydroxylase =hydroxylations and dealkyliations are reaction of modification performed by liver P450

enzymes.These enzymes shows genetic polymorphisam within the P4502C and P4502d group.Basicly

this means that patients will react different on the same dose of drug,cause their biotransformation will be

differente.. (got this from another forum)

12. The organism was Borrelia recurrentis

1. 68 yo woman with lower back pain after carrying groceries. Took no meds or HRT. Tenderness over

lumbosacral spine, neuro exam normal.

comp ression fracture L4

I t 's an old lady who is post-menopause, so she 's at r isk for osteoporosis --> she 's not on any

meds or HRT --> increased r isk of fractures. Side note: I th ink L4 is the m ost commonly fractured

vertebra, but I don ' t th ink you had to know that for th is quest ion.

2. This one got a graph so I'm just gonna explain it.. Newborn with respiratory distress syndrome asking


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which cell is secreting surfactant. How can you tell which 1 is type2 pneuomocyte!?

I t 's D, the cel l that's within the intersti t ium instead of ou tside of i t l ike that alveolar macrop hage

(E). A is the endoth el ial cel l , B is th e RBCs, and C is the type I pneumo cyte making its th in

epi the l ium.

3. Biostat Q comparing surgery done at tertiary center vs community care facility. I put unequal sample

sizes but it's wrong. Any thoughts?

I be lieve I put lack of contro l of case complexi ty for th is one. You can sort o f ru le out a l l of the

other ones because they ' re ei ther not true o r not re levant to the study . It k ind of m akes sense

because you ' re deal ing w i th mo rta li ty , which can h appen for a lo t of reasons, but I don ' t have a

defini te or clear explanation for yo u.

4. X-ray of the humerus asking which nerve is in danger. I put median N because it looks like the fracture

was near medial olecranon? But guess that isn't the case...

I t 's the radial nerve, and it was a midsh aft fracture of the humerus, which ten ds to inju re thatnerve.

5. A slice image of the pons asking where the substantia nigra pars compacta is. Anyone got a good

source where I can review these brain slices?

No good source, but the answer w as C, as seen here:http://www.upright-health.com/images...t ia-

nigra3.png

6. which of the following receptor classes are found in both presynaptic and postsynatic terminals

alpha2

Rememb er the alpha-2 receptors th at si t on the presynaptic term inals? Wh en NE is released, they

bind s ome of that NE and inhibi t i ts release.

7. 74yo man unable to repeat phrases and name objects after left sided stroke. Reading comprehension

preserved but difficult reading aloud and writing. Speech is fluent, comprehension normal. Which of

following is damaged

arcuate fasiculu s

Speech fluent, com prehens ion norm al. That el iminates Bro ca's and Wernicke's right off the bat.

Repeti t ion imp aired --> arcuate fasciculu s.

8. A slice image of the pons/medulla asking certain chromosomal abnormalities can result in rudimentary

development of the cerebral hemispheres. What and which spot is this?

I t 's a l lud ing to the medul lary pyramids, which s hould b e the most anter ior structures.
http://www.upright-health.com/images/substantia-nigra3.pnghttp://www.upright-health.com/images/substantia-nigra3.pnghttp://www.upright-health.com/images/substantia-nigra3.pnghttp://www.upright-health.com/images/substantia-nigra3.pnghttp://www.upright-health.com/images/substantia-nigra3.pnghttp://www.upright-health.com/images/substantia-nigra3.png


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9. Long stem asking what best describes result of loss of PTH on vitD metabolism. I put decreased

intestinal absorption of dietary vitD... and it's wrong =/

PTH increases the in test inal absorpt ion of calc ium and pho sphate. The more c orrect answer is

decreased renal co nversio n o f 25-OH-vi tD to 1,25-OH-vi tD (PTH activates 1-alpha-OHase in the

PCT of the kidneys ).

10. 52yo man with gout, treated w/ indomethacin and now still has uric acid of 800mg/day(N300-600).

Which drug is most appropriate to decrease uric acid concentration for this guy?

Al lopur ino l is used for chron ic gout and for supp ressing the overproduct ion of ur ic acid , which is

the more correct answ er here. Colch ic ine is used in acute gout A TTACKS since i t has ant i -

inflamm atory effects, at least that's how I think of i t.

11. AIDS+ man treated on HAART started treatment w/ a hematopoietic growth factor and started having

dyspnea, muscle pain, vomiting. sinus tach. Which of following could cause this?

Sargramost im

Ppl online say it's filgrastim..?

I t 's not f i lg rast im because that 's w hat I put and i t w as wrong. I t 's sargramost im ; I looked i t up and

the side effects sho wed up in som e obscure PubMed art ic le.

12. Where is bicarb absorbed the most?

The process of bicarbonate reabsorption occur predominantly in the proximal tubule (about 90%). The

rest occur in the thick ascending limb and in the collecting tubule. All involve hydrogen ion secretion asshown in the diagram below. To completely reabsorb bicarbonate,the kidney must secrete 4320

meq/day of hydrogen ions in addition to the amount required to exrete the daily acid load.

13. relationship between giving dextrose than adh secretion in graph

14. if u inject a hormone that makes more platelets where do u inject it? Cytoplasm, cell membrane or

nuecleus of megakryote or hepatocyte ni the liver?

15. systolic ejection murmur at base that radiates to neck. ecg = LVH

a. dissection

b. bicuspid aortic valve (my ans)

c. mitral insufficiency

d. mitral stenosis

e. tricuspid stenosis


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Renal

Oval fat bodies are usually renal proximal tubular cells with lipid in the cytoplasm. Oval fat bodies are

usually a sign of nephrotic syndrome. They can be identified under microscope by their characteristic

'maltese cross' appearance. Fatty casts.

Behavioral Science

Normal


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Biochemistry


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Answer is probably Urea or Ammonia.


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form 6 incorrect

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